scoliosis is biopsychosocial

I believe my doctor didn’t make 

a mistake in measuring my bone age 

when he stopped prescribing my brace.

I believe my bones were 

skeletally mature, 

my spine was done growing,

and no curve 

should have happened

when it did– 

if bone immaturity was

the reason for my scoliosis.

20 degrees of continuing

curvature signaled

that my bones 

were not the only element

involved in creating my scoliosis.

perhaps they were responding

to a different asymmetry, 

not involved in

creating the curve at all. 

the fact that my

curve grew significantly 

after my bone age

was found to reach maturity

is the reason I know

scoliosis is more

than a bone issue. 

my spinal curve had

an initiator somewhere

else in my body or brain:

perhaps stress, perhaps

an undetected asymmetry

in the brain, 

perhaps trauma,

perhaps a combination,

perhaps something else.

but a respite from

the brace allowed

my spine to curve 

under no monitoring,

despite apparent bone maturity. 

outside of a

measurement error

or negligence, 

which I do not feel

was the case based

on thorough treatment

to this point,

a biopsychosocial model

of scoliosis is the

explanation I offer. 

science doesn’t make

definitive statements

about what causes scoliosis

because no overarching cause

has yet been identified.

but treatment progress

has been made 

in just one dimension,

treatment of the

bones directly.

the Boston brace design

came a long way from the

chin-high Milwaukee brace, 

a long way from being

bed-bound in a full body cast.

but what if a multidimensional

treatment approach

is more effective? 

new research places

scoliosis in a context

larger than just bones:

research indicates

correlations

between scoliosis and:

depression

sensory dysregulation

spatial awareness deficits

balance issues

visual impairment

atypical brain lateralization

chronic pain

poor body image

anxiety

psychological

correlations

with scoliosis: 

¹  during adolescence, a

diagnosis of scoliosis

is associated with

an immediate drop 

in self-esteem and

mental health.

residual depression

often remains in adolescents

with severe spinal curves.

researchers advocate

that assessment for

mental health issues following

a scoliosis diagnosis

becomes standard practice.

²  over half of pediatric

scoliosis patients present

with a psychological comorbidity.

³  compared to their peers,

mental health concerns

occur more frequently

in scoliosis patients,

especially: eating disorders

in younger teenagers,

mood disorders

in older teenagers,

& anxiety disorders.

^{4  *}concerns remain about

the transparency, methodology,

and reproducibility of studies 

on the psychological effects of scoliosis,

and more research is needed. 

*we are stuck on scoliosis

being a bone issue, so psychological

studies are underfunded.

⁵  clinically significant emotional

and psychological distress

is noted in ⅓ of adolescent

scoliosis patients.

psychosocial correlations

with scoliosis:

⁶  family-based group

interventions are found

to enhance psychosocial

wellbeing and resilience

in adolescent scoliosis

patients and their families.

⁷  female scoliosis patients

report poorer health-related

quality of life than male patients.

^{8  †}adolescent scoliosis patients

who are treated with a

brace report higher levels

than their peers of sexual distress

and difficulties in body image.

†(my experience supports

this research- see “quiet destruction”)

⁹ 50–69% of surgical adolescent

scoliosis patients are at risk

for psychosocial difficulties

at 2-year follow up.

¹⁰ support systems from

at least two sources

foster positive self-image

during treatment for scoliosis.

biological (non-skeletal)

correlations with scoliosis:

^{11  *}“atypical brain lateralization”

has been observed in

adolescent scoliosis patients,

potentially disturbing “body schema”

and adding to “neurodevelopmental features”

evident in scoliosis.

researchers recommend

interdisciplinary investigation and

approaches focused on altering

“stress-related mechanisms”

and increasing neuroplasticity.      

  *if someone would help

to explain this theory

to me, I’m all ears :) 

^{12 ††} in scoliosis patients, a relationship

exists between back pain in adulthood and self-image and mental health in adolescents. one study found the development of back pain was largely determined by one’s psychological makeup, suggesting that mental health issues may aggravate back pain.

^††see source 23 in resources post about pain theories

¹³ scoliosis patients consistently exhibit “difficulties in multi-sensory integration”.

¹⁴  in scoliosis patients, in addition to biomechanical spinal differences, “anatomical, biomechanical, and kinesiological changes” have been observed in muscle components of the eye.

we know scoliosis patients share biopsychosocial characteristics,

so we must focus future work on biopsychosocial treatments.

research and clinical practice will take its time

making careful steps forward.

until then, based on my lived experience,

i know scoliosis is not only a bone issue.

in cause and in effect,

scoliosis is a biopsychosocial condition.

Sources

¹ Kaliterna, P., Buljan, I., Šegvić, I., Čimić, M., & Žuljević, M. F. (2026). The Association of Receiving a Diagnosis of Idiopathic Scoliosis with the Self-Esteem and Mental Health of Pediatric Patients: A Cohort Study. Children (Basel, Switzerland), 13(7), 946. https://doi.org/10.3390/children13070946

² Chen, J.W., Koester, S.W., Liles, C. et al. Evaluating the prevalence of psychiatric comorbidities associated with pediatric scoliosis utilizing ResearchMatch. Spine Deform 12, 1583–1593 (2024). https://doi.org/10.1007/s43390-024-00926-8

³ Tanabe, Y., Aso, S., Matsui, H., & Yasunaga, H. (2026). Association between adolescent idiopathic scoliosis and mental health concerns: a retrospective cohort study using a Japanese health insurance claims database. Spine deformity, https://doi.org/10.1007/s43390-026-01515-7 

⁴ Kaliterna, P., Žuljević, M. F., Marušić, A., & Buljan, I. (2025). Completeness of Reporting and Intervention Description in Articles on Psychological Interventions for Pediatric Patients with Adolescent Idiopathic Scoliosis: A Meta-Research Study. Healthcare (Basel, Switzerland), 13(22), 2872 https://doi.org/10.3390/healthcare13222872

⁵ Sanders, A. E., Andras, L. M., Iantorno, S. E., Hamilton, A., Choi, P. D., & Skaggs, D. L. (2018). Clinically Significant Psychological and Emotional Distress in 32% of Adolescent Idiopathic Scoliosis Patients. Spine deformity, 6(4), 435–440. https://doi.org/10.1016/j.jspd.2017.12.014

⁶  Cheung, M-C., Leung, Y-M., Leung, K-T., Shi, Y., Cheung, J. P. Y., Law, Jerry, & Yip, Joanne (2026). Family-based group intervention revitalizes the psychosocial well-being of adolescents with scoliosis receiving brace treatment. Child and Adolescent Social Work Journal. https://doi.org/10.1007/s10560-026-01135-0

⁷ Shi, Z., Mao, Z., Xue, S., Chen, G., & Li, S. (2023). What is the relationship between health-related quality of life among scoliosis patients and their caregiver burden? A cross-sectional study in China. BMC psychology, 11(1), 346. https://doi.org/10.1186/s40359-023-01375-0

⁸ Ashkar, I., El Rayes, D., Habib, H., Zantout, R. Z., Muscogliati, E., Nocun, W., Muscogliati, R., Badhe, N., Quraishi, N. A., Salem, K., & Najjar, E. (2026). Beyond the curve: sexual and psychological health after adolescent idiopathic scoliosis treatment. Spine deformity, 14(3), 741–753. https://doi.org/10.1007/s43390-025-01259-w

⁹ Jalloh, H., Andras, L. M., Sanders, A., Iantorno, S., Hamilton, A., Choi, P. D., & Skaggs, D. L. (2023). Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period. Medicine, 102(3), e32610. https://doi.org/10.1097/MD.0000000000032610

¹⁰ Glahn Castille, M., Resendiz Ortega, S. Strong support systems foster positive self-image in patients with scoliosis. Discov Ment Health 5, 54 (2025). https://doi.org/10.1007/s44192-025-00180-y

¹¹   Chizaram, N., Gasanov, M., Goncharuk, Y., Rodkin, S., Rodkin, V., Skarzhinskaia, N., & Vasilieva, I. (2026). Idiopathic Scoliosis as a Conversion Reaction to Stress with the Neural Effect of a “Distorting Mirror”. Life, 16(2), 270. https://doi.org/10.3390/life16020270

¹²  Lau, K. K. L., Kwan, K. Y. H., Cheung, J. P. Y., Law, K. K. P., & Cheung, K. M. C. (2023). Impact of mental health components on the development of back pain in young adults with adolescent idiopathic scoliosis. European spine journal, 32(11), 3970–3978. https://doi.org/10.1007/s00586-023-07908-w

¹³   Wang, D., Tsang, R., Li, Q., Chen, F., Vasanthi, R. K., Purushothaman, V. K., & Wang, S. (2025). Sensory integration dysfunction in adolescent idiopathic scoliosis: Insights from a clinical balance assessment using the m-CTSIB. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 136, 111267. https://doi.org/10.1016/j.jocn.2025.111267

¹⁴   Batın, S., Uçar, İ., Payas, A., Bal, E., Ekinci, Y., Kurtoğlu, E., Arık, M., Seber, T., Yılmaz, H., Kahraman, N., & Unur, E. (2023). Can Adolescent Idiopathic Scoliosis be Associated with Visual Impairment?. Journal of clinical practice and research, 45(4), 385–391. https://doi.org/10.14744/cpr.2023.08108